Long Term Results of a Comparative Study of Percutaneous and Surgically Created Proximal Forearm Arteriovenous Fistulae.

OBJECTIVE

This retrospective, single centre, comparative effectiveness study aimed to compare the long term outcomes of percutaneous arteriovenous fistula (pAVF) and surgically created arteriovenous fistula (sAVF) created in the proximal forearm for haemodialysis access.

METHODS

Data were reviewed from a prospectively maintained database on patients who underwent pAVF or sAVF creation from September 2017 to September 2023. A total of 217 pAVFs (61 WavelinQ and 156 Ellipsys) and 158 sAVFs were analysed. Outcome measures included technical success, maturation, patency, time to first successful use, re-interventions, and complications.

RESULTS

Technical success was 100% for sAVF and Ellipsys, and 93.4% for WavelinQ (p < .001). Maturation at four weeks was higher in Ellipsys (78.6%) and sAVF (79.7%) groups than in WavelinQ (64.9%) (p = .042). Median time to first cannulation was shortest for Ellipsys (57 days), followed by sAVF (73 days), and longest for WavelinQ (98.6 days) (p = .048). Mean follow up was 654 days (interquartile range 164, 1049 days; range 0 - 2061 days). Primary patency was higher in sAVFs than in pAVFs. The Cox proportional hazard ratio (HR) for loss of primary patency was 1.50 for WavelinQ and 1.42 for Ellipsys compared with sAVF (p = .045). Secondary patency was statistically significantly lower for WavelinQ (HR 2.76; p < .001), but not for Ellipsys (HR 0.74; p = .33). Haemodialysis access induced distal ischaemia (HAIDI) was more common in the sAVF group with nine events (5.7%) compared with one for the Ellipsys (0.6%; p = .008). Re-intervention rates per patient year were comparable across groups (0.60 vs. 0.61 vs. 0.69 for sAVF, WavelinQ, and Ellipsys, respectively).

CONCLUSION

This study indicates that while all access types can provide long term functional haemodialysis access, sAVFs perform better in some outcome domains and pAVFs (particularly Ellipsys) in others, with sAVFs showing higher rates of HAIDI, yet lower rates of juxta-anastomotic stenosis. The findings underscore the importance of personalised vascular access planning, weighing immediate procedural outcomes against long term functionality.